These are the inventories of goods delivered to Vavuniya and Padaviya. These are inventoried and checked by the receiving doctors at each hospital. You can see the same in the Padaviya video above.

Padaviya

On arrival at Vavuniya Hospital, it was found that there were 2000 patients. According to the doctor they are equipped to handle 400 patients. The number of doctors has increased to eighty at present. The hospital was expecting 1000 additional patients the same night. To create space for the new arrivals, they needed to discharge around 850 patients. When patients are discharged, they are reluctant to leave the hospital premises. In this confusion the doctors are not sure who the discharged patients are.

The hospital is so overcrowded, that wherever possible; the wards are being expanded. There is a new section that is being built at present but will take some time to complete. There are people in every bit of space they can find along the sides of the corridors leading to the wards, even on the retention walls of the drains.

The wards that were visited seemed orderly despite the mayhem. An additional pediatric ward has been created, for malnourished kids. Malnourishment is rife amongst adults and children alike. Most of the patients are suffering from pneumonia according to the doctor.

The two contagious diseases that are being dealt with are Chickenpox and Hepatitis A. These patients are together in a separate section due to lack of space. The patients with Chickenpox are contracting Hepatitis A, and vice-versa.

Their stores seemed to have only about, quarter of the space occupied by medicines on arrival. However, after the ACT delivery the rest of the space was utilised. This included the mattresses, linen, pillows, milk food, cereals etc.

The doctor was very happy with the ‘ACT members’, personal contribution of chocolates and coffee, to be shared by all the doctors. Unfortunately they don’t seem to have a common room at their disposal, for their breaks (if they do have time for it!). The present ‘common room’, seems to be a demarcated lobby area, where there is a couch for them to get some rest! Therefore, it was a great ‘thank you’, for the remarkable job being done, under stressful conditions.

Above is the video documentation of the trip and below is a photo gallery. This is of Padaviya, Vavuniya documentation will be added shortly.

ACT members present

• Govindha Tidball
• Indi Samarajiva
• Simon Wijegooneratne
• Thamara Spitzner

Accompanied by 2 lorry loads, 2 drivers including 1 Supervisor provided by the Medical Supplies Division, Ministry of Health, Sri Lanka.

Contact person Padaviya District Hospital

Dr. Mahinda Uyangoda

District Medical Officer

General

The two ACT teams traveling to Vavuniya and Padaviya Hospitals separated at Medawachchiya check point. The lorries were thoroughly checked for approximately two and a half hours following which the teams went their separate ways.

Upon arrival the general atmosphere of the hospital was very quite; there were no persons/families settled outside nor were there any new patients being brought in. Very evident was the large stock of government provided medicine boxes piled up in the corridors as well as ongoing construction work at the site.

Dr. Uyangoda was available in his office and immediately requested staff to ready the wards and army personnel to grant us permission to visit the factory where patients with minor injuries and their families had been settled. District Hospital staffs were requested to ready themselves to assist us with unloading the lorries.

Dr. Uyangoda welcomed us in to his office and gave us a general overview of the current situation at the hospital. He stated that things had drastically changed within the last two days; the government had provided large quantities of very basic medicines required and was upgrading the hospital through major renovations.

At present the hospital had 300 patients with the capacity to host another 100. In total 3 surgeons, 15 doctors, 60 nurses and 70 minor staff were based at the location.

Dr. Uyangoda was very pleased with the donation of medicines provided by Heart to Heart. He stated that Padaviya Hospital was currently overstocked with basic medicines in order to manage well but did not have anything extra to treat for example fungal skin conditions, the latest outbreak very apparent in children being Scabies.

Examining the inventories Dr. Uyangoda decided on sending excess toys and clothes to the factory where the need was more apparent. He was very particular about ensuring that each item inventoried was delivered especially with regard to expensive medical equipment. He was overjoyed to receive the ultrasound scanner (which they did not have), foldable as well as water mattresses which he said would be extremely useful for his patients. Concerning the large stock of milk he said there is a huge need for high energy food and drink at the factory where he would advise army personnel to distribute according to how they normally do.

2 lorry loads

The MOH drivers, Padaviya hospital nurses and ACT members unloaded the lorry. Dr. Uyangoda requested that the person in charge of medicines and inventories assists us. As a time consuming matter he suggested that the Heart to Heart medicines are checked at a later stage, he promised to sign and seal the list and fax ACT as well as MOH a copy of it. The majority of toys, all foldable mattresses and most of the milk powder were separated for the factory by which time permission was granted for us to visit.

Dr. Uyangoda suggested that we move on to visiting the wards while distributing toys.

Wards

Everything was in order and several beds had been made vacant at the time of visit as Padaviya hospital serves as a transfer hospital, once patients stabilize they are bussed out to make room for the next ones coming in. Roughly 20% of the patients that come in are in critical condition, the rest have minor wounds. At any given time Padaviya hosts 200 patients in addition another 100 local patients were on site. When IDP buses come in the total number will swell to around 500 patients. As soon as the patients stabilize they are sent across to one of five hospitals depending on the availability of space (GH Polonnaruwa, Dambulla Base Hospital, Kurunegala Teaching Hospital, Vavuniya Hospital or Mannar).

The toys were a huge hit with the children, the number one request among the toys that we had were for cars, even among the girls (many wanted to exchange an initial toy for a car if at all possible). In discussion with the ACT team it was recommended to send in toys again. The people really lit up when the box was opened. More importantly next time if possible toys that spark more social involvement and interaction among the children should be included i.e. cricket bats, soccer balls etc. space in the factory field for this type of activity was available and ongoing.

Factory

The factory though not so well maintained as the hospital had an almost full ward of females including a few new born babies. The general impression is that the level of hygiene is poor due to so many flies on the infants and very dirty toilets. Scabies was very apparent in many, Dr. Uyangoda pointed out many children with this skin condition. The men’s ward was rather empty upon our arrival they were all smiles. It was nice to see two of them enjoying a nice game of chess. Our visit at the factory was short as we had to get to Medawachchiya before 6.00p.m in time for road closure. We observed if could be said a lot of happiness amongst the children in the factory field engaged in a serious game of cricket. Therefore it is suggested that equipment for group activity is sent in the next delivery.

Dr. Uyangoda stated that he would be in touch with us about specific medicines, equipment and any other items required by the hospital. He sincerely together with the nurses thanked us for the gift items and our visit.

REPORT OF IMPRESSIONS GATHERED DURING MINISTRY OF HEALTH SPONSORED VISIT TO DH PADIVIYA AND GH VAVUNIYA

BY PROFESSOR A.H. SHERIFFDEEN, ACCOMPANIED BY DR. JAYALAL

All in all the doctors, nurses and minor staff together with the paramedical staff are doing a heroic dedicated service. They work almost 20 hours per day with the arrival of every new batch of patients which is once every 2 to 3 days! It is almost a miracle that the health of this staff has been able to withstand the trauma both physical and mental. The stories that the patients come out with are unbelievably tragic and will no doubt affect the health of the patients and staff treating them in the long term. They need to be protected.

Doctors interviewed: Dr. Bhavani Pasupathiraja, Medical Superintendent who appears confident and in total control of the difficult situation and appeared to command the respect of all grades of staff; Dr.Purupananda, MO Anaesthesia who was familiar with almost every patient in the ICU and wards, working well above the call of duty; Dr. Akhilan Registrar, Surgery who was confident and looked capable.

Conclusions: Sending extra staff is a priority. Whilst the logistics of this are being worked out, it is important that at least the equipment and consumables requested are sent as soon as possible so that the doctors working under trying conditions are made aware that the Ministry is listening to them and trying to help.

STAFF

Surgeons with SHOs work round the clock dealing with emergencies and infected wounds, resulting from delayed access to treatment. The delay is caused by the difficulty faced by patient in getting to a medical facility from the site of injury. Infected compound fractures are the rule rather than the exception.Extra MOs for Wards urgently needed especially since WHO and Pradesha Sabha  funded temporary Wards are coming up.

Anaesthetist  SRs support the surgical team admirably. They could do with extra medical officers in OT and more in the Wards.

Permanent orthopaedic Surgeon urgently required. External fixators required for the compound fractures.

EQUIPMENT & CONSUMABLES

• OT: Sutures 3/0 and 5/ Proline needed. Also needed are bone wax, Gelfoam and artery forceps of all sizes. Elastoplast and Micropore plasters needed in OT and Wards.
• ICU: Requires a Paediatric ventilator and 2 Monitors. Total Parenteral Nutrition (TPN) solutions are not available.
• Extra supplies of inotropes: adrenaline,dopamine, dobutamine needed.
• 3 way urinary catheters required especially for patients with haematuria.
• Path Lab: no facilities for Histopathology and Microbiology. The latter is urgently needed in view of the large number of infected wounds.
• Consumables: consumption of antiobiotics and analgesics very high needing urgent replenishment of stocks.
• Cefuroxime (intravenous) is not available and urgently needed.
• Other frequently use antiobiotics are Co amoxyclav, Ciprofloxacin, Metronidazole, Cloxacillin and oral Norfloxacin
• Children’s Ward requirements: Children’s clothes, basic washable toys, educational material.
• Nebulizer
• Consultant Physician needs the following: 4 adult and 1 paediatric nebulizers
• Calcium resornium sachets for management of over 100 patients in chronic renal failure. Initially 1000 sachets.
• Azithromycin 250 mg tabletsx 200
• Tramadol tablets 50 mg x1000
• Antibiotics and analgesics are consumed rapidly since over 90% wounds are infected

General: Packets containing the following will help: Plastic Mug/cup, Plastic plate, soap, sarong/sari/children’s clothes, male/female. Numbers are difficult to predict. An INGO supplies such packets on arrival. There are over 2000 patients in the Wards with another 500 to 600 accompanying persons/family/children in the Hospital.

It is a well run hospital, under the care of Dr. Bavani Pasupathyrajah (Medical Director, Vavuniya Hospital).  The sheer number of patients is the major problem they are facing.  Of these, a very large number were children under the age of 5. There were a lot of babies and breast feeding mothers, newborns and toddlers with injuries.

Based on the data collected and upon request from the doctors in Vavuniya, Phase 1 Part 2 will include another delivery of relief items to Vavuniya.

Padaviya Hospital

Emergency treatment is provided as civilians come off the boats in Pulmodai.  Patients with a good chance of survival are dispatched to Padaviya Hospital.

Our Trust Chairman Professor A.H Sheriffdeen travelled to Padaviya Hospital on 19th April 2009, to assess the medical situation.  He confirms that treatment facilities are overcrowded and Padaviya Hospital is over capacity (despite an expansion into a donated garment factory). Human resources are limited (doctors, junior doctors, nurses, orderlies) and as such, need to be expanded.

As expected, there were a large numbers of babies and children under 5. Total number of patients is around 1,500.

Pulmodai Field Hospital

Very little data is presently available to ACT.  Reports range from the existence of a fully equipped hospital, to quick “on-the spot” emergency treatment facilities after which, patients are transferred to Vavuniya or Padaviya. We will be researching how to help Pulmodai Field Hospital shortly.